Question(s) about chronic pain management

[Guest guest]

I've recently run some calls on patients with chronic pain, as opposed to acute

musculoskeletal pain. I've noticed something unusual about chronic pain

patients, particularly those with fibromyalgia. I've noticed (anecdotally) that

chronic pain patients more often seem to be female and often have a psychiatric

diagnosis which may include bipolar disorder, anxiety, or depression. Is there

a neurochemical link between these psychiatric conditions and chronic pain?

Also, has anyone out there considered different pain management protocols based

on chronic versus acute pain? On first blush, it would seem that one might want

to consider the use of a benzodiazipine or even Phenergan to help with relaxing

the chronic pain patient as much as we'd want to consider narcotic analgesia. Or

is there something completely different that EMS might want to consider adding

to our pharmaceutical arsenal to help our patients with chronic pain?

Thoughts anyone?

Thanks!

-Wes Ogilvie, MPA, JD, EMT

Austin, Texas

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[Guest guest]

Wes, my husband is a chronic pain sufferer and takes massive meds to function

every day. Because of that, I know that folks with chronic pain typically

develop depression and even anxiety as part of the disease process. From things

I have read, it is thought that dealing with pain on a constant basis kind of

provides sensory overload as well as other issues which can lead to them

becoming depressed and easily upset. Many patients who suffer from rheumatoid

arthritis, fibromyalgia, back injuries, etc have to also take anti-depressants

and sometimes even sedation agents for rough periods just to be able to function

and/or to rest.

Also, patients who take pain meds, especially high-powered pain meds, become

physically dependent on the medication, which is not the same thing as

addiction. They have to have the meds, so giving them other pain management

doesn't lead to addiction as some might believe. It also tends to lead the

patient to developing a higher tolerance to pain meds and, in an acute pain

situation maybe even caused by another condition such as trauma or whatever,

they may very well still need even MORE pain meds to get through that episode

and it may require an even larger quantity of pain meds to achieve pain relief

from the new condition.

Pain meds should NEVER be withheld from anyone in pain including someone who

takes pain meds on a daily basis. A good physical assessment will tell you

first if the patient is suffering from depressant actions of their current meds

which might mean you may have to be careful or withhold more pain meds.

Otherwise, I am a huge fan of monitoring whether or not the patient's brain is

actually " feeling " a reduction in pain and whether or not the body KNOWS that

pain meds are on board by monitoring waveform capnography - baseline and then

after the dose. If you give a patient a pain med and 5 or 10 minutes later the

patient says he is still in pain and there is no noticeable change in the capno,

it is usually safe to administer more drug. If the patient is saying he is

still in pain but now the waveform is longer and/or reading higher than it was

before, then it probably indicates that the BRAIN has noticed and " felt " the

pain med. The pain may still not be under control so that does

n't necessarily preclude another dose, but you may consider doing half doses or

withholding more meds for a little while to see how their response goes from

there. (This is also extremely useful in dealing with elderly patients in which

you may be using smaller increments in an attempt to keep from overdosing

them.)

Don't know if I helped or not, and there is a lot more to the picture than this.

I am sure others on here can fill in more, but at least I got the response

started for you.

Jane Hill

-------------- Original message from ExLngHrn@...: --------------

I've recently run some calls on patients with chronic pain, as opposed to acute

musculoskeletal pain. I've noticed something unusual about chronic pain

patients, particularly those with fibromyalgia. I've noticed (anecdotally) that

chronic pain patients more often seem to be female and often have a psychiatric

diagnosis which may include bipolar disorder, anxiety, or depression. Is there a

neurochemical link between these psychiatric conditions and chronic pain?

Also, has anyone out there considered different pain management protocols based

on chronic versus acute pain? On first blush, it would seem that one might want

to consider the use of a benzodiazipine or even Phenergan to help with relaxing

the chronic pain patient as much as we'd want to consider narcotic analgesia. Or

is there something completely different that EMS might want to consider adding

to our pharmaceutical arsenal to help our patients with chronic pain?

Thoughts anyone?

Thanks!

-Wes Ogilvie, MPA, JD, EMT

Austin, Texas

__________________________________________________________

Check out the new AOL. Most comprehensive set of free safety and security tools,

free access to millions of high-quality videos from across the web, free AOL

Mail and more.